340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
AVITA PHARMACY 1044
HV0413130A MONTGOMERY AIDS OUTREACH, INC.
Print
Covered Entity Details
Entity Name
MONTGOMERY AIDS OUTREACH, INC.
Subdivision Name
Dothan
Type
Ryan White Part C
340B ID
HV0413130A
Entity Address
1865 Honeysuckle Road
Suite 3
Dothan, AL 36305
Grant Number
H76HA00099
Participating Start Date
4/1/2013
Last Recertification Date
1/31/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1044
Pharmacy Address
AVITA DRUGS ALABAMA LLC D/B/A AVITA PHAR
3220 5TH AVE S STE 110
BIRMINGHAM, AL 35222-2309
Pharmacy Comments
Contract Details
Approval Date
1/9/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Michael R. Murphree, Chief Executive Officer
(334) 280-3349 Ext: 1001
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
1/9/2020
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session